Mentally ill offenders in prison: the Belgian case

According to the EUPRIS-study on mental health in prisons (2007), available data on mental disorders in prison are scarce. Therefore, this study aims at summarizing and discussing the available knowledge on incarcerated mentally ill offenders concerning: (1) the screening and assessment for detecting mental health; (2) the psychiatric expertise in order to evaluate the mental status; and (3) the development and provision of forensic psychiatric treatment and care. These findings will be applied to the current situation in Belgium, which is a particularly interesting case. Belgium is currently facing difficulties concerning a large population of interned mentally ill offenders residing in correctional establishments.Implications with regard to the penal code, general or mental health legislation, screening, assessment, and treatment could deliver interesting viewpoints on how this problem could be tackled more effectively. Therefore, the findings will be discussed with reference to the international scientific and policy debate, focusing on ethical implications.     

The processing and disposition of incompetent mentally ill offenders

Pretrial hospitalization of mentally ill offenders has been increasing in recent years and a number of abuses have been noted with respect to competency to stand trial. This is a report on 431 male felony defendants who were found incompetent to stand trial, hospitalized, and returned to court for a final disposition. Approximately one-half of those brought back to the court gained release to the community, with one-half continuing to be held in a hospital or a prison, and with 70% continuing in treatment in one setting or another. Disposition was significantly related to race, criminal history, severity of charges, and the recommendations of mental health professionals. Offenders were found to have spent unnecessarily long periods of time in jail and in the hospital awaiting court processing, raising questions about the fairness and efficiency of current procedures.     

A comparison of rape and molest offenders in prison psychiatric treatment

Differences in offense history, brain functioning, and psychological functioning of rape (n = 45) and molest offenders (n = 15) who were receiving psychiatric treatment while in prison were evaluated. Significant differences were found in each of these domains. Rape offenders were more likely to have histories of high violence offenses other than sexual offense, including murder, serious juvenile offenses, and both juvenile and adult sexual offenses. Rape offenders were more likely to show lower intellectual functioning and diffuse brain dysfunction associated predominantly with temporal and prefrontal brain cortices. Rape offenders were also more likely to display psychological functioning associated with illogical thinking and disordered attachment but less immature self-focus and fewer feelings of alienation than demonstrated by molest offenders. Implications for treatment and social policy for sexual offenders are suggested. Logistic regression demonstrated that these neuropsychological measures resulted in 71.7% accurate prediction and Rorschach measures resulted in 79.2% accurate prediction in differentiating rape from molest offenders. Implications for theoretical understanding of sexual offending are discussed.     

Stability of life-time psychiatric diagnoses among offenders in community and prison settings

The dearth of studies investigating diagnostic stability among offenders, and diagnostic stability being important from the patient’s mental health perspective, as well as from a public health, training and research standpoint, highlights the need to evaluate lifetime stability of ICD-10 psychiatric diagnoses for offenders in community and prison settings. A case-linkage design linked a two-year population-based cohort of male-sentenced prisoners with a state-wide psychiatric register (23,742 psychiatric consultations). Four measures of diagnostic stability were calculated for each setting as well as across settings, for all offenders who received at least two psychiatric diagnoses. Temporal consistency was moderate for schizophrenia spectrum disorders and low for affective, anxiety and personality disorders, and was higher in prison setting than community settings. Diagnostic instability highlights that the course of mental illness and clinical features among offenders may genuinely vary over time, across community and prison settings and may lead to complexities regarding psychiatric care for this population     

A psychometric comparison of internet and non-internet sex offenders from a community treatment sample

Abstract

This paper compares psychometric test assessments of 39 men convicted of internet sex offences with 39 convicted of contact offences against a specific victim. Higher rates of socially desirable responding were identified in the internet group, as well as higher rates of emotional loneliness and under assertiveness, although the latter two findings were not statistically significant. This group also achieved lower scores measuring external locus of control, which might reflect their generally higher levels of education and employment (identified from research carried out in tandem with this work). The internet group achieved lower scores on sexualized attitudes towards children, emotional congruence with children and empathy distortions with regard to victims of child abuse. Hence, although they exhibited the kinds of general personality problems exhibited by other sex offenders, they did not support attitudes that explicitly endorse or condone the sexual abuse of children. This paper presents some hypotheses about these results and identifies further research necessary to develop understanding about this new kind of sexually abusive behaviour.     

Understanding how sexual offenders compare across psychiatric and correctional settings: examination of Canadian mentally ill sexual offenders

Abstract

Much of what is known about sexual offenders is based on correctional samples and then applied across settings based on the assumption that this group is homogeneous. In this study, 149 files were compared, including 108 cases from the forensic mental health system (FMH) and 41 cases from the correctional system (COR). Although many similarities were observed between the FMH and COR groups, the results also revealed important differences. The FMH group was characterised by more frequent hospitalisations, higher rates of major mental illness and single status. The COR group was characterised by a history of physical and sexual abuse, family history of addictions, more intrusive sexual offences and higher rates of offending. These results highlight different profiles for sexual offenders in forensic mental health and correctional settings and challenge us to consider the implications for assessment, treatment and risk management of this unique group of sexual offenders.     

Family Support Groups for family members of mentally ill offenders: a pilot study

To date, there is a lack of family interventions for family members of persons with a mental illness who offended (PMIO). With the aim of addressing this issue, a Family Support Group (FSG) has been developed. The current pilot study investigated the impact of two pilot FSGs for family members of PMIO in relation to quality of life, burden, coping strategies, and resilience. Family members completed several questionnaires (i.e. WHOQOL-BREF, ZBI-22, CERQ, RS-nl) both before and after the group intervention. A total of 20 family members participated in both FSGs. The results indicated that participants experienced less self-blame, a decrease in loss of control over their lives, and improved emotional well-being. The findings showed that attending an FSG can be empowering for family members as it offers support in the management of emotional experiences and coping strategies.     

Reintegrating seriously violent and personality-disordered offenders from a supermaximum security institution into the general offender population

Offenders who have committed serious violent acts while incarcerated are often segregated and housed in supermaximum security facilities. Given the highly restricted regime under which they are detained, it is often difficult to decide if they are safe enough to be discharged. However, there is a need to reintegrate them into the general offender population in a lower security institution for humane, correctional, and financial reasons. We propose a transitional strategy to facilitate their reintegration by way of a maximum-security step-down treatment-oriented facility within which both their security requirements and treatment needs could be adequately met. The present study reports the results of such an approach. More than 80% of the offenders (n = 31) were reintegrated into a lower-security facility without relapsing and being returned to the supermaximum institutions within a follow-up period of 20 months. They also have lower institutional offense rate postreintegration compared to prereintegration.     

The assessment of continued threat to the community in a mentally ill offender program

Community based outpatient treatment for Mentally Disordered Sex Offenders and those found not guility by reason of insanity are based on controversial empirical grounds. The present research examines how mental health evaluators determine when an offender is or is not a threat to the community for purposes of program continuance. Of 13 variables identified by the staff of the offenders' program or from the literature as important in making this prediction, three were found to be related to the evaluation decision: initial psychiatric diagnosis, the presence of supportive relationships in the community, and improvement in therapy. These findings are discussed in terms of the empirical and philosophical literature on psychiatric detention and treatment.